RESUMO
AIM: To investigate the relationship between p wave terminal force (Ptfv1) and pericardial thickness in patients with tuberculous constrictive pericarditis. METHODS: From January 2018 to October 2022, 95 patients with tuberculous constrictive pericarditis who needed pericarditis dissection in a hospital were collected, and 3 patients who did not meet the criteria were excluded, a total of 92 cases. The absolute value of Ptfv1 in conventional electrocardiogram was tested before surgery, and pericardial thickness was measured by echocardiography and chest CT. Pericardial thickness was measured after pericardial dissection. Pearson correlation analysis was used, R software was used to make scatter plot, and non-parametric square test was used. The correlation of postoperative measurements with echocardiography, chest CT and absolute value of Ptfv1 was analyzed. RESULTS: Pearson correlation analysis was conducted with postoperative measurements and echocardiography measurements, postoperative measurements and chest CT measurements, and postoperative measurements and absolute value of Ptfv1. Pearson correlation analysis showed that the correlation coefficients between postoperative measurements and echocardiography, chest CT and Ptfv1 values were statistically significant. Scatter plot and nonparametric Chi-square test showed that postoperative measurements were consistent with absolute values of echocardiography, chest CT and Ptfv1 (p < 0.05). And this study found that the distribution of the value of Ptfv1 ≥ 5 was higher than the value of Ptfv1 < 5 after pericardiectomy (0.95:0.05) in the absolute value of Ptfv1 ≥ 0.04 which measured before pericardiectomy. The hypothesis was statistically significant (p < 0.05). CONCLUSION: The absolute value of Ptfv1 in electrocardiogram can be used as an auxiliary diagnostic index to evaluate pericardial thickness in tuberculous constrictive pericarditis.
Assuntos
Pericardite Constritiva , Pericardite Tuberculosa , Humanos , Pericardite Constritiva/diagnóstico por imagem , Pericardite Constritiva/cirurgia , Pericárdio , Pericardite Tuberculosa/diagnóstico por imagem , Pericardite Tuberculosa/cirurgia , Ecocardiografia , Eletrocardiografia , PericardiectomiaRESUMO
A 66-year-old woman was admitted to our hospital due to chest distress and shortness of breath during 1 week. Transthoracic echocardiography (TTE) revealed massive pericardial effusion and multiple, irregular and high-density echo "tumor-like" masses on the heart, with the largest one on the apex. However, there were no masses found by computed tomography (CT) scan, except for increased lipids around the coronary artery. We performed emergency pericardiocentesis and drainage to relieve symptoms. The positron emission tomography/CT (PET/CT) also showed several ununiformly high accumulations in pericardial cavity. However, the high-density echo "tumor-like" masses cannot be seen by TTE after pericardiocentesis, and also cannot be detected when surgery. Pericardiotomy was performed due to severe pericardial adhesion. The diagnosis of tuberculosis (TB) was confirmed by pericardiotomy and pericardial biopsy.
Assuntos
Neoplasias , Derrame Pericárdico , Pericardite Tuberculosa , Feminino , Humanos , Idoso , Pericardite Tuberculosa/complicações , Pericardite Tuberculosa/diagnóstico por imagem , Pericardite Tuberculosa/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Pericárdio/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Neoplasias/patologiaRESUMO
Extrapulmonary tuberculosis (TB) contributes to 15% of total cases, representing a great diagnostic and therapeutic challenge. Pericardial involvement is present in 1 to 2% of TB patients and is considered an unusual presentation form of TB. We report a 67-year-old male presenting with fever and progressive dyspnea. A chest CAT scan showed a bilateral pleural effusion and an extensive pericardial effusion. An echocardiogram showed signs of tamponade. Therefore, an emergency pericardiectomy was performed. The pathological report of pericardial tissue showed caseating necrosis and its Koch culture was positive. The patient was treated with anti-tuberculous drugs with a favorable evolution.
Assuntos
Derrame Pericárdico , Pericardite Tuberculosa , Tuberculose , Ecocardiografia , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Pericardiectomia , Pericardite Tuberculosa/diagnóstico , Pericardite Tuberculosa/diagnóstico por imagemRESUMO
We report a case of 37-year-old man implanted with cardiac resynchronization therapy-defibrillator presented with persistent low-grade fever and sudden loss of left ventricular (LV) capture from coronary sinus lead after generator replacement. 18 F-fluorodeoxyglucose positron emission tomography with computed tomography scan showed increased uptake at posterolateral region of the pericardium adjacent to the LV lead, suggestive of possible lead-related infection. Combined percutaneous and surgical lead extraction revealed purulent pericarditis and polymerase chain reaction testing confirmed tuberculous (TB) pericarditis. TB pericarditis is an unusual cause of loss of LV capture, but should be considered in countries where TB is still endemic.
Assuntos
Terapia de Ressincronização Cardíaca , Seio Coronário , Insuficiência Cardíaca , Pericardite Tuberculosa , Adulto , Dispositivos de Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pericardite Tuberculosa/diagnóstico , Pericardite Tuberculosa/diagnóstico por imagemRESUMO
Extrapulmonary tuberculosis (TB) contributes to 15% of total cases, representing a great diagnostic and therapeutic challenge. Pericardial involvement is present in 1 to 2% of TB patients and is considered an unusual presentation form of TB. We report a 67-year-old male presenting with fever and progressive dyspnea. A chest CAT scan showed a bilateral pleural effusion and an extensive pericardial effusion. An echocardiogram showed signs of tamponade. Therefore, an emergency pericardiectomy was performed. The pathological report of pericardial tissue showed caseating necrosis and its Koch culture was positive. The patient was treated with anti-tuberculous drugs with a favorable evolution.
Assuntos
Humanos , Masculino , Derrame Pericárdico/etiologia , Derrame Pericárdico/diagnóstico por imagem , Pericardite Tuberculosa/diagnóstico , Pericardite Tuberculosa/diagnóstico por imagem , Tuberculose , Pericardiectomia , EcocardiografiaAssuntos
Antituberculosos/uso terapêutico , Pericardite Tuberculosa/diagnóstico , Pericárdio/patologia , Biópsia , Erros de Diagnóstico , Coração/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Pericardiectomia , Pericardite Tuberculosa/diagnóstico por imagem , Pericardite Tuberculosa/tratamento farmacológico , Pericárdio/microbiologia , Pericárdio/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Pericardite Tuberculosa/diagnóstico , Antituberculosos/uso terapêutico , Biópsia , Progressão da Doença , Quimioterapia Combinada , Humanos , Linfonodos/microbiologia , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Pericardiocentese , Pericardite Tuberculosa/diagnóstico por imagem , Pericardite Tuberculosa/tratamento farmacológico , Pericardite Tuberculosa/patologia , Pericárdio/microbiologia , Pericárdio/patologia , Prednisona/uso terapêutico , Avaliação de Sintomas , Tomografia Computadorizada por Raios X , Tuberculoma/microbiologia , Tuberculoma/patologiaAssuntos
Pericardite Constritiva/etiologia , Pericardite Tuberculosa/complicações , Antituberculosos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Pericardite Constritiva/diagnóstico por imagem , Pericardite Constritiva/patologia , Pericardite Constritiva/terapia , Pericardite Tuberculosa/diagnóstico por imagem , Pericardite Tuberculosa/patologia , Pericardite Tuberculosa/terapia , Tomografia Computadorizada por Raios XAssuntos
Humanos , Feminino , Adolescente , Pericardite Tuberculosa/diagnóstico , Pericardite Tuberculosa/tratamento farmacológico , Pericardite Tuberculosa/diagnóstico por imagem , Tuberculose/complicações , Ecocardiografia Doppler , Corticosteroides/uso terapêutico , Antibióticos Antituberculose/uso terapêuticoRESUMO
Tuberculosis is still the leading cause of pericardial disease in developing nations. A definite diagnosis of tuberculosis is usually relatively difficult, especially when its manifestations are not typical. We report a 19-year-old man who presented with chest obstruction, shortness of breath, edema of the lower extremities, and mild fever for 14 days. The manifestations of tuberculosis pneumonia were not typical, except for a small high-density shadow in the left upper lung field near the pleura, with a small amount of pleural effusion on chest computed tomography. The tuberculin skin test, acid-fast stain of sputum and pericardial effusion, and bacterial culture showed negative results. Echocardiography showed three free-floating irregular masses in a large amount of pericardial effusion. The masses and exudates were removed by pericardiectomy. The masses were composed of hyperplastic granulation tissue and dead tissue without a normal architecture, mixed with numerous caseous substances, which confirmed the diagnosis of tuberculous pericarditis. This is a unique report of a patient who presented with tuberculous pericarditis with multiple solid masses in a large amount of pericardial effusion, without typical clinical manifestations of tuberculosis.
Assuntos
Neoplasias Primárias Múltiplas/diagnóstico , Derrame Pericárdico/diagnóstico , Pericardite Tuberculosa/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/patologia , Pericardiectomia , Pericardite Tuberculosa/diagnóstico por imagem , Pericardite Tuberculosa/patologia , Tomografia Computadorizada por Raios X , Adulto JovemAssuntos
Ecocardiografia , Coração/diagnóstico por imagem , Imageamento por Ressonância Magnética , Pericardite Constritiva/diagnóstico por imagem , Pericardite Tuberculosa/diagnóstico por imagem , Idoso , Antituberculosos/uso terapêutico , Glucocorticoides/uso terapêutico , Coração/efeitos dos fármacos , Coração/fisiopatologia , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Pericardite Constritiva/complicações , Pericardite Constritiva/tratamento farmacológico , Pericardite Constritiva/fisiopatologia , Pericardite Tuberculosa/complicações , Pericardite Tuberculosa/tratamento farmacológico , Pericardite Tuberculosa/fisiopatologia , Valor Preditivo dos Testes , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologiaRESUMO
CASE PRESENTATION: A 63-year-old man presented with a 12-month history of recurrent dyspnea, dry cough, fatigue, and weight loss. He denied chest pain, fever, or chills. Chest radiographs during those months revealed bilateral pleural effusions, and he was subjected to serial thoracenteses. Pleural fluid analyses suggested invariably a transudate, and he had received an empirical antiheart failure regimen for several months. However, his symptoms did not improve. He reported no smoking or alcohol use and his medical history was unremarkable.
Assuntos
Pericardite Constritiva/diagnóstico por imagem , Pericardite Tuberculosa/diagnóstico por imagem , Diagnóstico Diferencial , Dispneia , Humanos , Masculino , Pessoa de Meia-Idade , RecidivaRESUMO
Tuberculosis-associated pericardial disorders are an excessively rare manifestation of extrapulmonary tuberculosis. The patients may present with constrictive pericarditis or pericardial fluid accumulation leading to cardiac tamponade. This paper reports a case of tuberculosis-associated pericardial effusion with dense fibrinous material not causing tamponade in a foreigner presenting with nonspecific symptoms. It also provides a discussion about the diagnostic and therapeutic methods as well as interesting echocardiographic images of the patient.
Assuntos
Ecocardiografia/métodos , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/microbiologia , Pericardite Tuberculosa/complicações , Pericardite Tuberculosa/diagnóstico por imagem , Antibacterianos/uso terapêutico , Antibióticos Antituberculose/uso terapêutico , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Etambutol/uso terapêutico , Feminino , Humanos , Isoniazida/uso terapêutico , Pessoa de Meia-Idade , Derrame Pericárdico/tratamento farmacológico , Pericardite Tuberculosa/tratamento farmacológico , Rifampina/uso terapêutico , Estreptomicina/uso terapêuticoRESUMO
BACKGROUND: Posttubercular constrictive pericarditis is prevalent pericardial disease in developing countries. Pericardiectomy is the treatment of choice but considered a procedure of high morbidity and mortality. METHODS: From January 2003 to December 2013 we performed 130 pericardiectomies. The patients' mean age was 22.95 ± 12.55 years, and there were 92 (71%) male patients. All patients were symptomatic; 118 (91%) were in New York Heart Association functional class III or IV. Almost all patients were diagnosed to be of tubercular origin: 14 (11%) were histopathologically proven, 77 (59%) had definitive history, 39 (30%) were suspected to be of tubercular origin, and 91 (70%) received prior antitubercular treatment. RESULTS: Anterior pericardiectomy was done without the use but with provision for cardiopulmonary bypass, which was required in 5 (3.8%) patients for repair of tear in right atrium. Following pericardiectomy central venous pressure dropped from 20.9 to 10.8 mm Hg. Early mortality was 10 (7.69%). Prolonged ventilation was required in 22 (16.92%) patients, 31 (23.84%) developed renal dysfunction, and there were 3 (3.12%) cases of new-onset atrial fibrillation. On analysis of univariate predictors for early mortality, low ejection fraction (p < 0.001) and preoperative atrial fibrillation (p < 0.001) were found to be significant. In a follow-up of 12 months, 85% patients were in New York Heart Association functional class I or II with mean ejection fraction of 52%. There was no recurrence of constriction from residual pericardium on 1-year follow-up. CONCLUSIONS: Anterior pericardiectomy is sufficient in patients with constrictive pericarditis of infective etiology. Preoperative low ejection fraction, atrial fibrillation, poor functional class, and constrictive effusive pericarditis results in poor surgical outcome.